News

Doctors Seek Organ Donation from Deaths Outside of Hospitals

David Wahlberg

07/05/2015

July 05--Less than 2 percent of the 2.6 million Americans who die each year qualify for organ donation, largely because most people die outside of hospitals and hospital deaths generally are required for donation.

Some doctors are advocating for a new type of donation -- from people who die of cardiac arrest at home, in emergency rooms or other places outside of inpatient hospital units.

First responders, after exhausting resuscitation efforts, would ask to preserve the bodies with solutions or machines. They or others would seek consent for donation.

The idea, allowed in France and Spain, is called "uncontrolled donation after circulatory determination of death." It could generate 22,000 more donation opportunities per year, more than the 14,000 or so annual donors in the U.S. today, according to the Institute of Medicine, a nonprofit that advises Congress.

"The U.S. organ donation system is not leveraging an approach that could expand the pool of potential donors," Dr. Stephen Wall and colleagues at the New York University School of Medicine wrote in May in the Journal of the American Medical Association.

The federal government funded pilot programs in New York and Pittsburgh in 2007. Nine deaths were considered but didn't qualify in New York, and Pittsburgh's study yielded only two kidneys. The disappointing results were mostly because the studies required previous consent for donation, Wall and others wrote last year in the Annals of Emergency Medicine.

Dr. Thomas Egan, of the University of North Carolina-Chapel Hill, is studying transplants of lungs recovered from people who die suddenly outside of a hospital. The research is supported by a $4.2 million grant from the National Institutes of Health.

The University of Michigan Health System approved donation from cardiac arrest victims in the emergency room, but doctors haven't done any because most patients are resuscitated or declared dead in the field, said Dr. Jeffrey Punch, a transplant surgeon at Michigan. A new intensive care program in the ER might change that, Punch said.

Doctors who reviewed the concept for the federal government expressed concerns last year about the ability to confirm circulatory death or brain death in the field.

"Detailed neurologic examinations to directly establish 'brain death' usually cannot be performed ... in the few minutes available," wrote the group's leader, Dr. James Bernat, a neurologist at Dartmouth College in New Hampshire.

Dr. Tony D'Alessandro, a transplant surgeon at UW Hospital, said UW Hospital has no plans to try donation from deaths outside of hospitals in Wisconsin. But the idea could be beneficial, he said, especially if it was expanded to deaths from trauma.

"A lot of the deaths that occur outside of the hospital are young, healthy people in traumatic accidents," D'Alessandro said. "There's potential there."